Breast cancer no longer has to be a death sentence, thanks to early detection and better treatments. In fact, according to the Centers for Disease Control and Prevention, women are 8 times more likely to die of heart disease than breast cancer. Get the real story behind 10 common mysteries...

Mystery #1: If I have a lump in my breast, it’s definitely cancer.False. At least half of all visits to breast clinics are for lumps, but most are benign, says Richard J. Bleicher, M.D., assistant professor in the surgical oncology department at Fox Chase Cancer Center in Philadelphia.

Breast lumps can be benign tumors, cysts and fibrocystic changes, which come and go with fluctuating hormones during menstrual cycles.

“You can sometimes even feel a [breast] lymph node”— a bean-shaped piece of tissue that’s part of the immune system, Bleicher says.

If you find a lump, have it evaluated by a doctor even if you’ve had benign ones before, he says.

Mystery #2: I can’t get breast cancer – it doesn’t run in my family. False. Many women say, “‘I don’t need a mammogram or a breast check because I don’t have a family history of breast cancer,’” says Karen Karsif, M.D., the director of the Breast Center at New York Hospital in Queens, N.Y.

But 85% of all breast cancers aren’t genetic, she says.

Most inherited breast cancers are related to BRCA1 or BRCA2 (breast cancer gene 1 and 2). Women with the genes have five times the chance of developing breast cancer than women without them. And women of Eastern European Jewish descent are five times more likely than the general population to carry the genes.

Women should be tested for the genes if they’re at risk, Karsif says.

Yet a lot of women overestimate the risk.

“If you have one family member in her 60s or 70s who has breast cancer, that doesn’t increase risk,” she says.

But if you have two or more close relatives on either parent’s side who have had breast or ovarian cancer before age 50, talk to your doctor about genetic testing.

Mystery #3: Women with big breasts have a higher cancer risk.False. “It’s the architecture — not the size — of the breast that matters,” says Dalliah Black, M.D., a breast cancer surgeon at Hoffberger Breast Center at Mercy Medical Center in Baltimore.

Cancers are easier to miss in dense, or fibrous, breasts than in the fattier ones most of us get as we age.

“Dense breast tissue is white on a mammogram and breast cancer is usually white,” Karsif explains. “In a woman under 50, you can miss many more breast cancers, depending on how dense the breast is.” And smaller breasts tend to have more density.

Researchers have found that the enzymes and proteins in dense breast tissue are also different from those in fattier versions, Black says.

But they don’t know which ones influence breast cancer risk, she says.

“You can have small breasts and have the enzymes and proteins and be more likely to get breast cancers.”

Mystery #4: Teenagers can get breast cancer.True. Even women in their teens can develop breast cancer, although it’s rare, Bleicher says: In most cases involving young women, a lump will be benign but should be evaluated by a doctor.

Women should start monthly breast self-exams at 30 and mammograms at 40 — although there’s no harm in starting earlier.

“But because young women’s breasts are more dense, it’s very difficult to feel something,” Bleicher says. “At 30, the breasts are less dense.”

And the better you know your breasts, the easier you can detect change, Karsif says.

“Self-exams are about raising awareness.”

Mystery #5: Trauma — including pressure from underwire bras — can cause breast cancer.False. “Trauma from a bra or falling down has no relationship to breast cancer,” Karsif says.

Anxiety is the root of this myth, she explains. “People would like to say, ‘If I do this or this, I won’t get breast cancer.’ It’s a lot easier to believe there’s a reason why you get breast cancer.”

Mystery #6: A breast cyst can’t turn into cancer.True. Cysts can’t turn into breast cancer, although there are cystic breast cancers, which make up 1%-3% of breast cancers.

“They have abnormal rugged edges with fluid, but also a mass,” Black says. “A benign cyst is smooth and purely fluid.”

About 30% of women have fibrocystic breast changes or cysts that move within the breast tissue.

Still, a cyst can feel like a lump and it’s tough to know from a self-exam if the lump is fluid or solid, Bleicher says. See a doctor for any lump that lasts longer than a menstrual cycle.

Mystery #7: If I remain cancer-free five years after breast cancer treatments, I won’t get it again.False. Once you’ve had breast cancer, you’re always at risk for its return, Black says.

The level of risk depends on several factors, including the kind and stage of cancer you had. For example, the aggressive HER-2 positive breast cancer — is more likely to resurface within 5-10 years. Estrogen receptor positive tumors — those fed on estrogen — tend to come back 10-20 years later.

Having a mastectomy lowers your risk.

“But the doctor has to leave a little fat under the skin because that’s where the blood vessels supply the skin,” Black says. “So a cell could be left that turns into cancer.”

According to a 2008 study at the M.D. Anderson Cancer Center in Houston, five years after treatment, women had recurrence rates of 7%, 11% and 13%, depending on whether they had, respectively, stage 1, 2 or 3 tumors.

Mystery #8: All breast cancer isn’t the same.True. Breast cancers vary in action and origin, Bleicher says. The most common kinds are ductal or lobular, a difference detectable only under a microscope.

Ductal cancers come from cells that line the ducts, which carry milk from the breast lobules to the nipple. Lobular cancer comes from the cells in the small lobes where breast milk is produced.

Cancers that haven’t spread outside the ducts or lobules are called in situ, or noninvasive cancers. But once cancer has spread, it’s invasive.

Less-common breast cancers include those that don’t begin in a duct or lobule but in the surrounding breast tissue or that stem from another kind of cancer (such as non-Hodgkin’s lymphoma) that has spread from another part of the body.

Mystery #9: If my breast lump is painful, it must not be cancer.Mostly true. “That’s true for the most part, but breast cancers can hurt,” says Black, who has some cancer patients who complain of pain.

Inflammatory breast cancer, which accounts for 1%-6% of breast cancers, can announce itself through redness, inflammation, swelling and skin dimpling — but it isn’t always painful.

And mammograms miss many more cancers in younger, denser breasts. Older breasts are fattier than young ones and fat is black on mammograms, a clear contrast with the white of cancer.

Women with dense breasts should ask for an ultrasound with their mammogram, but ultrasounds — an imaging system using sound waves to create pictures of tissue — can’t be ordered routinely, Karsif says.

The reason is three-fold:

The accuracy of a breast ultrasound is only as good as the expertise of the technician.

Breast ultrasounds are labor intensive: A technician must move the transistor over the entire breast so every piece of tissue is seen.

Ultrasounds frequently pick up small nodules in women who are menstruating at the time. A biopsy proves to be benign 99% of the time, but it creates unnecessary anxiety for the patient.

“It’s really opening up a big black box if you’re doing ultrasound as a standard for everyone,” Karsif says. “It’s not a great screening tool.”

What makes the most sense? Annual mammograms, breast exams and monthly self-exams will make early detection more probable. Talk to your doctor about whether you should get an ultrasound as well.

What’s Your Breast Cancer Risk?The biggest risk factor for developing breast cancer is simply being a woman, though a small percentage of men develop it, too. Fortunately, with better screening processes for early detection, breast cancer doesn't have to be fatal. Find out your risk with this breast cancer quiz.

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